ALBI and APRI score as prognostic factors for predicting the FABIB complications after liver resection in metastatic colorectal cancer.
Authors: Elena Napolskaia, Timur Andabekov, Badri Sigua, Maria Rodina, Alina Khlobystina, Elizaveta Gulo
Journal: Journal of Clinical Oncology (2023)

e15577 Background: Previous studies and this study demonstrate that liver resection, even with subsequent extrahepatic relapse, may be associated with long-term survival, are very encouraging for future studies of the effectiveness of liver cytoreduction in conditions of minimal extrahepatic disease. These data also contribute to selective cytoreduction in extrahepatic sites. If it is necessary to achieve an oncological result (maximally extended liver resection), sometimes the surgical result suffers in the form of postoperative complications. The most serious complication of liver resection due to colorectal cancer metastases is postoperative liver failure, characterized by high levels of INR and bilirubin by day 5 after surgery. Methods: To classify the most frequent postoperative complications, the FABIB system has been developed, which includes Failure, Ascites, Bile leakage, Infection, Bleeding. We tried to evaluate the possibilities of using the ALBI and APRI indicators as one of the factors that must be taken into account when predicting the development of complications from the FABIB group. ALBI score is used in predicting the development of liver failure in patients with hepatocellular cancer. APRI score is a predictor of fibrosis and cirrhosis in patients suffering from hepatitis. Results: We have analyzed the results of liver resections in 174 patients with metastatic liver damage in colorectal cancer. Among them 57% are women, 43% are men. Metastatic lesion of the right lobe – 38 (21.8%), the left lobe – 78 (44.8%), right and left lobes – 58 (33.4%). Right–sided tumors - 25% - 43 patients, left–sided tumors - 75% - 131 patients. According to the FABIB classification, liver insufficiency was observed in 25 patients (14%), ascites in 4 patients (2.3%), bile leakage in 8 (4.6%), infectious complications in 9 (5%), bleeding in 15 patients (8%). A single-factor analysis of the variance of ALBI and APRI indicators on the day of surgery, the day after surgery and on the 5th day after surgery did not show a statistically significant difference in the groups with all FABIB complications and without FABIB complications. However, statistical analysis separately in each subgroup of complications revealed a statistically significant difference in ALBI and APRI in the groups with and without postoperative liver failure, as well as a statistically significant difference in the groups with and without bleeding. Conclusions: Thus, it can be concluded that ALBI score and APRI score can be used in the early postoperative period to predict the development of postoperative liver failure and hemorrhagic complications not only in patients with hepatocellular cancer or cirrhosis, but also in patients with colorectal cancer with liver metastases. It could be useful in patients who have undergone several lines of chemotherapy before liver resection or with a large tumor lesion of the liver.